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long term sedation options

Posted

Specializes in CTICU, Burn ICU, STICU.

Interesting article. Especially when cost effective! I find at my facility, we do not use this combination enough (IMO)

What do you use at your facility??? Opening the floor do discuss this article.

http://ccforum.com/content/18/3/R122/abstract

ausrnurse

Specializes in ICU. Has 4 years experience.

Usually midazolam which we change to propofol or dexmedetomidine in the days prior to extubation. We do a lot of early trache's so most of our long term ventilated patients do not require sedation.

JeanOfAllTraits

Has 2 years experience.

Fentanyl and propofol together is our standard practice. Depending pn the ICU some are better than others on sedation interuptions and weaning to minimally necessary levels. In the day or two before extubation I try to have minimal sedation and allow the pt to let me know of he or she would "like to feel less/more sleepy" or if having pain. I try to use bumps of fentanyl rather than increasing the rate, especially as we get closer to extubation. If we're having difficulty weaning sedation we'll start precedex in the last 24 hrs as we wean down the sedation.

Depending on the attending I feel like we wait a while to trach, obviously leading to longer sedation days.

We do mostly fentanyl and propofol. Midazolam is most common in the first day or so...we usually stop it after that. We also use a lot of dexmed, but then many of our vented patients are awake-ish. (A travel nurse working with me commented on how surprising that had been to her when she started at our hospital.)

spacemonkey15

Specializes in Critical care. Has 11 years experience.

Depends on the patient and what's wrong with them, morphine and midazolam (versed to most of you guys) is a pretty common combination we go for with people needing longer term sedation. We tend to trachy people who require long term ventilation, so like the other poster, sedation isn't needed as much as we wake them so we can attack their rehab while they wean off the vent.